Provider Demographics
NPI:1467461988
Name:BAROUTA-KHARZO, MARIAM ELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ELIA
Last Name:BAROUTA-KHARZO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3001 GREEN BAY ROAD
Mailing Address - Street 2:NORTH CHICAGO VETERAN ADMINISTRATION MEDICAL CENTER
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:847-688-1900
Mailing Address - Fax:224-610-2913
Practice Address - Street 1:3001 GREEN BAY ROAD
Practice Address - Street 2:NORTH CHICAGO VETERAN ADMINISTRATION MEDICAL CENTER
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:224-610-2913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA825072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry